Agency/Division Information

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agencys core values include passion for purpose trust and transparency empowerment and accountability best in class and outcome-driven and servant leadership. As part of the interview process candidates may be required to attend an in-person interview at our Oklahoma City office.

Position Purpose

The Behavioral Health Specialist is responsible for evaluating the medical necessity appropriateness and quality of care for members receiving behavioral health services. This role involves conducting clinical record reviews liaising with providers and assessing member needs to ensure effective care delivery. By monitoring treatment progress addressing barriers to care and identifying necessary services the specialist supports optimal health outcomes. Additionally the position aims to foster collaborative relationships both within and outside the organization contributing to the continuous improvement of behavioral health services in alignment with the Oklahoma Health Care Authoritys mission to provide better health and care for Oklahomans.

Principle Activities May Include:

• Evaluate medical necessity care appropriateness and quality through clinical record analysis and provider communication. Distinguish between convenience and necessity ensuring clear and professional communication with providers.

• Monitor treatment progress and engagement assessing ongoing member needs through regular contact with involved parties. Link members to necessary services by identifying treatment needs and available resources.

• Identify and address barriers to provider participation and member access offering recommendations for policy improvement. Address issues affecting member participation and access to services.

• Cultivate effective relationships within and outside the organization to fulfill responsibilities effectively. Foster partnerships internally and externally to optimize member support.

• Optimize member care delivery through integrated management of pre-approvals quality control and care coordination activities.

• Other duties as assigned.

Knowledge Skills Abilities and Competencies

The Behavioral Health Specialist position requires in-depth knowledge of clinical and behavioral health practices state and federal healthcare policies and program administration. Key skills include the ability to evaluate care quality communicate effectively with providers and coordinate services across various stakeholders. The role aligns with the Decision Quality and Collaborates Korn Ferry competencies as it requires sound clinical decision-making and strong collaboration with internal and external partners to ensure optimal care delivery.

Education and/or Experience:

• Current and valid license behavioral health license such as: Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT) in the state of Oklahoma AND

• A masters degree in psychology counseling human relations clinical/direct practice social work or a closely related field which must have included one semester of at least three hundred hours of applied clinical practicum in psychology or counseling plus one year post-masters experience providing professional counseling services.

Preference may be given to candidates with:

• Certifications in any of the following areas: Certified Case Manager (CCM) Certified Addiction Specialist (CAS) Crisis Prevention and Intervention (CPI) Certification or Project Management Professional (PMP)

• SoonerCare experience

• State or federal government work experience

• Experience with an integrated healthcare delivery system

• Experience in utilization management and/or inpatient psychiatric hospital position

• Experience in care coordination/case management

Physical Demands:

• Must be able to remain sitting for prolonged periods at a desk and working on a computer.

• Must be able to move or lift up to 15 pounds at various times.

Work Environment

The office work environment includes regular exposure to general office equipment such as computer equipment phones and copy machines.

Why Youll Love Working Here

At the Oklahoma Health Care Authority (OHCA) were proud to create a workplace where employees thrive. Named a Top Workplace in Oklahoma for five consecutive years this achievement reflects the dedication and collaborative spirit of our incredible team. Heres what we offer to support employees and their family:

• Generous state-paid benefit allowance to offset insurance premiums.

• A wide selection of top-tier health insurance plans.

• Optional flexible spending accounts for health care or dependent care expenses.

• Employee Assistance Program (EAP) offering confidential support.

• Wellness benefits including an on-site gym and fitness center discounts.

• 11 paid holidays annually.

• 15 vacation days and 15 sick days in your first year.

• Retirement Savings Plan with substantial employer contributions.

• Longevity Bonus to reward years of service.

• Public Service Loan Forgiveness eligibility and reimbursement for educational expenses.

• Professional development training opportunities including CEU support.

Accommodation Statement:

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate. All qualified applicants will receive consideration for employment without regard to race color sex religion disability age national origin or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact the Civil Rights Coordinator at .

Notice to applicants:

Please add to the address book or safe-senders list in your email. All correspondence will come from this address. Be sure to check your junk folder. If you have questions about the status of your application you can contact the HR team at .

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees must apply for open positions internally through WorkdayJobs Hub.